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Re: [IPk] High sugars in early morning and after set change

Hi Colin
If you look closely, the actual rise in BG after breakfast is quite small (6 
mmol/l) so you're not far off. You need to be giving a correction bolus for 
the 13.6 as well as the 5 units for the 75g carb. Also remember that when 
your BG is high, it often takes more insulin to bring it back down.
So I suspect if you started out with a BG of, say, 5 mmol/l, it would only go 
up to about 8 or 9 (which is fine) after your Bran Flakes with 5 units.

About the set changes - a few things to try.
(1) leave the old set in for a couple of hours after you've put the new one 
in. Sometimes bits of insulin continue trickling through during that time.

(2) change the set before a meal, when you're going to be bolusing. Sometimes 
the set needs a kind of kick-start to get going.

(3) try increasing the prime a little. I use the SIhouette and although the 
recommended prime for that is 0.8 units, I find 1 unit works better for me 
(don't ask why!).

Great news about the funding!

On Monday 29 July 2002 11:20, you wrote:
> I finally started on a pump two weeks ago, and am currently in the process
> of trying to get Basal rates stabilised.  I have noticed two things which
> both affect me during mornings.
> Firstly, my BMs shoot up when I get up/after breakfast (I haven't yet
> determined what happens if I don't eat breakfast).  One morning I tried
> testing regularly to see what happens and these were my results (My target
> BM at present is 10):
> 06:30	13.6
> 06:40  Breakfast (Bran flakes + semi-skimmed milk) 75g CHO, 5.0 unit Bolus
> 07:00	16.3
> 07:20	19.5
> 07:45	16.1
> 08:30	17.3
> 09:30	15.2
> I wouldn't expect a meal like that to induce such a rapid rise in BM, but
> it is completely repeatable day after day.  Has anyone else had a similar
> experience?
> Secondly after a set change (9mm/43" Quickset) my sugars always go a lot
> higher during that morning and will usually require a couple of correction
> Boluses to get back into normal range.  I am confident that I am doing the
> set change correctly, priming the set, and giving a 0.5 unit prime bolus to
> fill the cannula after insertion.  Again has anyone seen anything similar
> and have any constructive ideas?
> The good news is that I have been fully funded for both Pump and
> consumables.  This was all done for me by the Pump Clinic at Guy's, who
> contacted my health authority (Sth Essex) and arranged funding.  This was
> all done before I could see Dr. Pickup for the first time (Which happened
> back in January). I had initially been referred at about this time last
> year.  Since January, Guy's have tried tweaking a few things with MDI and
> using a Glucowatch and Minimed CGMS to look in detail at what goes on,
> before coming to conclusion that a pump would be appropriate.  This
> decision was then made in May, which meant a new financial year and
> therefore re-applying for funding.  Fortunately this came through fairly
> quickly and I started on Saline on 9 July, and on Insulin on 15 July.
> 	Colin - MM 508 2 weeks.
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